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Apnea and sleep state in newborns and infants
1Laboratoire de Physiologie, INSERM CJF 8909, Hôpital A.-Beclere, Clamart, France.
Insights
Infants experience more breathing pauses during active sleep. Factors like fever, maternal medication, and sleep deprivation can worsen these events, especially in preterm infants.
Area of Science:
- Neonatal Physiology
- Sleep Medicine
- Respiratory Control
Background:
- Active sleep is characterized by increased apnea frequency in healthy newborns and infants.
- This phenomenon is linked to central nervous system mechanisms active during active sleep.
- Homeostatic disturbances can exacerbate respiratory instability during this sleep stage.
Purpose of the Study:
- To investigate how specific factors influence apnea occurrence during active sleep in infants.
- To determine the impact of altered homeostasis on respiratory events in newborns and preterm infants.
Main Methods:
- Observational study analyzing respiratory events during sleep.
- Controlled experiments involving induced hyperthermia in preterm infants.
- Assessment of apnea frequency following maternal meperidine administration in term newborns.
- Evaluation of respiratory events after induced sleep deprivation in infants.
Main Results:
- A 0.8°C increase in body temperature significantly augmented periodic breathing in preterm infants.
- Maternal meperidine administration increased apnea frequency in term newborns during active sleep in early life.
- Sleep deprivation led to more obstructive respiratory events during active sleep compared to quiet sleep.
Conclusions:
- Active sleep represents a vulnerable period for increased apnea frequency when infant homeostasis is challenged.
- Factors such as elevated temperature, maternal analgesics, and sleep deprivation pose risks for respiratory instability in infants during active sleep.
Abstract:
Many studies have shown a greater frequency of apneas in active sleep than in quiet sleep in healthy newborns and infants, both full-term and preterm. The ontogeny of increased apnea during active sleep is related to phasic inhibitory-excitatory central mechanisms occurring during active sleep. Respiratory instability in active sleep can be increased by factors which modify the newborn's or infant's homeostasis. We have shown: (1) an increase in body temperature (0.8 degrees C) significantly augments periodic breathing in preterm infants at 40 weeks postconceptional age; (2) maternal administration of meperidine is followed by a significant increase in number of apneas during the first hours of life in full-term newborns, but only during active sleep; (3) sleep deprivation induces significantly more obstructive respiratory events in active sleep than in quiet sleep in infants. Active sleep appears to be a risk period for exaggeration of the occurrence of apneas when the newborn's or infant's homeostasis is disturbed.